Hashemi Sayed Jalal, Soltani Hasanali, Heidari Sayed Morteza, Rezakohanfekr Mahmoud
Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2013 Mar 6;2:9. doi: 10.4103/2277-9175.107971. Print 2013.
Postoperative pain relief is important in procedures of the lower extremity. Several previous studies have evaluated the efficacy of intra-articular (IA) pethidine as a compound, which has local anesthetic and opioid agonist properties, on postoperative pain relief in arthroscopic knee surgery (AKS). This study compared the postoperative analgesic effect of pre- and post-surgical IA pethidine administration in AKS.
Seventy-five patients of American Society of Anesthesiologists (ASA) I and II undergoing AKS with general anesthesia were enrolled in this double-blind study. Patients were randomized in three equal groups to receive either 50 mg IA pethidine before surgical incision incision and saline after skin closure (PS), saline before surgical incision and pethedine after skin closure (SP), and only saline at two different times (SS). In each patient with operated knee joint, pain at rest and joint movement was evaluated at 1, 2, 6, 12, and 24 h after surgery completion using Visual Analog Scale (VAS). Data were analyzed using analysis of variance (ANOVA)-repeated measure, t-paired, and Chi-square tests.
Postoperative pain score at rest and joint movement in PS group was significantly lower than those in other groups. The time (Mean ± SD) between completion of operation and patient's request for morphine, total morphine consumption (Mean ± SD) in postoperative 24 h, and the numbers of patients requesting analgesic in PS, SP, SS, groups were: 5.2 ± 1.3, 3.3 ± 1.5, and 2 ± 1.3 h (P < 0.05); 4.4 ± 2.4, 8.7 ± 2, and 11.6 ± 4.4 mg (P < 0.05); 11, 18, and 21 persons (P < 0.05), respectively.
The present study shows that preemptive intra-articular pethidine 50 mg injection is more effective than preventive injection for postoperative pain relief at rest and joint movement in arthroscopic knee surgery.
下肢手术中的术后疼痛缓解至关重要。此前有多项研究评估了具有局部麻醉和阿片类激动剂特性的复方关节腔内（IA）哌替啶在关节镜膝关节手术（AKS）中对术后疼痛缓解的疗效。本研究比较了手术前后关节腔内注射哌替啶对关节镜膝关节手术术后镇痛效果的影响。
本双盲研究纳入了75例接受全身麻醉下行关节镜膝关节手术的美国麻醉医师协会（ASA）I级和II级患者。患者被随机分为三组，每组人数相等，分别在手术切口前接受50mg关节腔内哌替啶注射且皮肤缝合后接受生理盐水注射（PS组）、手术切口前接受生理盐水注射且皮肤缝合后接受哌替啶注射（SP组），以及在两个不同时间点仅接受生理盐水注射（SS组）。在每个接受手术的膝关节患者中，术后1、2、6、12和24小时使用视觉模拟评分法（VAS）评估静息和关节活动时的疼痛情况。数据采用方差分析（ANOVA）重复测量、配对t检验和卡方检验进行分析。
PS组静息和关节活动时的术后疼痛评分显著低于其他组。手术结束至患者要求使用吗啡的时间（均值±标准差）、术后24小时吗啡总消耗量（均值±标准差）以及PS组、SP组、SS组中要求使用镇痛药的患者人数分别为：5.2±1.3、3.3±1.5和2±1.3小时（P<0.05）；4.4±2.4、8.7±2和11.6±4.4mg（P<0.05）；11、18和21人（P<0.05）。
本研究表明，在关节镜膝关节手术中，术前关节腔内注射50mg哌替啶比术后注射在缓解静息和关节活动时的术后疼痛方面更有效。
